Employees Behavioral Health with Lifestyle Medicine Denise Fields, - - PowerPoint PPT Presentation

Alternatives to Managing Employees Behavioral Health with Lifestyle Medicine

Denise Fields, PharmD, FASHP Nicole Williams, MBA, PCMH CCE, OTC

April 15, 2016

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Have you ever heard or said…..

• “Just take a few of my leftovers…”
• “My sister will never miss one or two of these, and I have a huge

headache…”

• “I was just borrowing a couple of pills from an old bottle of medicine

in the cabinet...”

• “I store all these in case someone needs them sometime…”
• “Dad will never notice they are gone...”
• “We just have not had time to go through all these drugs since

grandpa passed away…”

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Most Indiana comp. impacted by RX abuse…

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http://www.nsc.org/NSCDocuments_Advocacy/FINAL20%Media%20briefing%20PPT.PDF

Diabetes

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Diabetes

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Diabetes

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Diabetes

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Diabetes

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Why are people abusing Pharmaceuticals?

• Easy to obtain
• Cost effective – especially with insurance!
• Perceived to be more safe
• Easier to conceal
• Generally odorless
• Dosage Consistency
• Everyone’s doing it!

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Objectives:

• Audience will be able to describe methods to reduce

the risk of behavioral health issues in effected workers and their peers

• Audience will understand different approaches for

managing employees with behavioral health issues

• Audience will understand key lifestyle strategies and

non-pharmacologic treatments

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How Employers can get started:

1. Recognize prescription drugs have big impact on your workplace 2. Put strong policies in place 3. Expand drug testing panels to include opioids 4. Train supervisors and employees how to spot signs 5. Treat substance use problems as a disease 6. Leverage EAP to assist employees to return to work

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How Can Employers Reduce Risk

• Policy and procedure

– Drug Screening – Medication specific policies for the workplace

• Education

– Lunch and Learn offerings – Plant program

• Supervisor training
• Employee education
• Sustainability structure

– Health Champions – Vendor collaboration

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POLLING QUESTION #1

Which of these policies do you have in place now?

• A. Drug testing
• B. Employee use of drugs without a prescription
• C. Return to work for employees undergoing substance

abuse treatment

• D. Employee use of prescription drugs at work
• E. All of the above

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Policy Best Practices

• Address non-medical use of prescription and over-the-counter

medications in the policy

• Include prescription medications in drug testing panel and policy
• Provide guidance to employees on when it is okay to use medication

at work and if they should report this use

• Be able to assign employees to alternate work tasks while on

medication

• Provide information about how to access employee benefit and

assistance programs

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Identify Approaches for managing employees with behavioral health issues

• Implement a Collaborative Care model with full

integration of SHARED evidenced-based depression guidelines

Allow patients to choose treatment modality for depression as part of Shared-Decision Making and lifestyle Integration

• Antidepressants
• Psychotherapy

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Identify Approaches for managing employees with behavioral health issues

• Implement Medication Management
• Implement a Depression Care manager( Behavioral

Health therapist, LPC, social worker, or staff with education to support role)

– Collaborates closely with PCP in managing patient – Performs systematic initial and follow up assessments – Supports medication management

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Identify Approaches for managing employees with behavioral health issues

• Utilize Employee Assistance Program(EAP) as part
• f the Collaborative Care model

– Utilize full care team and allow them to support depression management to full extent of education and/or job scope

• Implement Active Care Management

– Involve all aspects of the care team in managing patients

• Lifestyle Coaching and motivational interviewing
• Implement Ancillary services to promote healthy living and
• verall well being

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Identify Approaches for managing employees with behavioral health issues

• Implement process for utilization of external

resources

– Social services – Community Based services

• Implement Psychiatric Consultation

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So, Are Your Efforts Addressing the Root Cause??

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Seven levers of health

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Substance Free Clean Water Physical Activity Sleep Stress Mgmt. Nutrition Clean Air

What’s your culture?

• Are your current practices and policies setting the cultural stage for sick

care and a dependence on medication? Or are your current practices and policies supporting health care?

• Do you hand patients information about dietary or lifestyle changes, or do

you teach them how to make the change (and then subsequently coach them through the process or change)?

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Setting the stage for Behavior Change

• Lifestyle electronic learning modules for employees
• Cummins Health Improvement Program (CHIP)

– 8 week corporate lifestyle education program – 18 hours of education with facilitated discussion – Groups of 30-40 participants – Whole of health approach – Biometric measurements to track progress

• Healthy Lifestyle Coaching
• Cummins Health Improvement Program (CHIP)

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POLLING QUESTION #2

Which of the following prescriptions might be appropriate for a patient with depression?

• A. Citalopram 20 mg by mouth once daily
• B. ¼ cup sunflower seeds once daily for 12 weeks
• C. 30 minute brisk walk five times weekly for 12 weeks
• D. All of the above

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Prescription for Lifestyle

• What if you wrote a prescription for (adjunctive therapy)?

– Nutrition to treat depression? – Physical activity to treat depression?

• What if you wrote a prescription on what food to add, and

not just what to take away?

– Positive Prescription

• Add ¾ cup of black beans 4 times per week for 12 weeks

– Negative Prescription

• Reduce cheese to no more than ¾ cup once per week for 12 weeks

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Be specific

Do you give instructions specific enough that a patient understands and can follow the prescription for lifestyle? – For nutrition, does your prescription include

• Type of food
• Amount of food
• Frequency of food

– For physical activity, does your prescription include

• Frequency
• Intensity
• Type (of exercise)
• Time (duration)

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Bringing it all together: The Cummins LiveWell Center

• Lifestyle Medicine implemented with PCMH foundation to support the care team
• Types of Services

 Acute Care  Well Visits  Referral and Coordinated Care with PCP, Specialists and High Performance Network Providers  Rotating Community Specialist and Primary Care Physicians  Dermatology Services  Women's’ services

• Teaching Kitchen
• Behavioral Health Services Stress Tests

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Bringing it all together: The Cummins LiveWell Center

• PFT – Spirometry
• Hearing
• Biometric Screenings
• moderately Complex Labs
• CLIA Waived Testing
• Immunizations and Vaccinations
• Travel Medicine
• Minor Procedures

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Do as I do, NOT do as I say

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What Questions do you have for Us??

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